Critical Test Results Management: The Human Touch

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 - doctor and patient

Critical test results management (CTRM) cuts to the heart of the healthcare business. U.S. hospitals complete approximately 12 billion radiology, laboratory and cardiology tests every year. Most are negative and don’t require follow up by the referring clinician. But a handful of test results, amounting to about 1 to 5 percent of a hospital’s test volume, are abnormal or critical. Hospitals have a legal, ethical and moral obligation to ensure that these results are communicated to the responsible physician or patient care team—and IT systems are now closing that loop.

Traditional systems to communicate and manage critical results are full of flaws. There is the manual phone call approach, but phones aren’t always answered or the wrong person might answer the phone. In many hospitals, contact information changes on a regular basis, and radiology departments may not have the correct information. Faxes can be equally problematic as the receiving machine might be off or out of paper. And once communicated, the right person might not receive the fax right away. Unfortunately, it’s not unheard of for it to take days for a radiologist to track the correct physician for results communication.

The problem takes its toll in a number of ways. For starters, hospitals must wrangle with legal and regulatory challenges. “Miscommunication of findings is a causative factor in 85 percent of radiology lawsuits,” reports Tom White, founder of Veriphy. And The Joint Commission (JC) set national patient safety as one of its top goals and requires hospitals to improve processes.

The flip side of the coin is productivity. Every day, radiologists, cardiologists and lab techs make two to three million calls to communicate test results, which can gobble an hour out of the work day for some highly paid specialists.

CTRM systems present a new paradigm. They tap into IT to streamline and automate the results communication process. Solutions not only improve patient safety, but also increase productivity among radiologists and other specialists. It’s a match made in heaven. Here’s how CTRM works.

The CTRM/workflow equation

One option in the CTRM market is Amicas’ RadStream workflow engine. Developed by the radiology department at Cincinnati Children’s Hospital in Ohio, RadStream is designed to address two key issues in radiology: improving critical results notification and reducing interruptions to workflow. The system meets its objectives, says Mark Halsted, MD, RadStream project leader and chief of the Radiology Informatics Research Core at Cincinnati Children’s Hospital.

A pre- and post-implementation analysis conducted by the College of Business at University of Cincinnati showed that Cincinnati Children’s Hospital radiologists conveyed and documented results in 5 percent of cases prior to RadStream. After deployment, notification and documentation jumped by an additional 15 percent without worsening workflow or increasing turnaround time.

The system works by removing the burden of communication from radiologists, and instead, placing responsibility for communication on human operators.

RadStream covers a number of common scenarios. If a referring physician orders a STAT study, RadStream automatically routes the results to a bank of operators via the internet. The first available operator opens the case and communicates the impression or full report to the ordering physician via the phone. The process differs slightly for any case with a critical finding. When a radiologist detects a critical finding, he or she can instant message an operator within the RadStream system. The operator phones the referring physician to bring him or her up to speed before connecting the radiologist and clinician. A final option covers cases where the referring physician may miss a finding such as a subtle pneumonia in an ED patient. In these cases, the radiologist routes the dictation to the operator, who, in turn, ensures that that clinician reads the report. In all cases, the operator documents the connection in a permanent record.

“Human interaction is key to the success of critical test results management,” asserts Halsted. Cincinnati Children’s Hospital taps into file room workers, transcriptionists and radiology extenders to monitor RadStream web interfaces and connect with physicians. “Anything less than human intervention can lead to suboptimal patient care,” he continues. Consider a recent case in which an operator insisted that a nurse physically bring